Individual
LISA A WALLACE
Active
Individual
LISA A WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
L1-0019627
DE
363L00000X
Nurse Practitioner
LG-0000511
DE
363LF0000X
Family Nurse Practitioner
Primary
LG-0000511
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LG-0000511
NP LICENSE NUMBER
DE
Enumeration date
01/22/2010
Last updated
03/13/2025
Update your record
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